attached to the extensor longus digitorum (Plate V.). The greatest care must be observed in the technic of this operation to have it thoroughly aseptic. The method that I have found the simplest and the best of transplanting tendons is to carry the sound tendon into a slit which has been made in the paralyzed tendon, securing it in place with interrupted sutures. Where tendons are carried for some distance for purpose of transplantation tunnels must be made for them with a blunt instrument beneath the subcutaneous tissue. The advantage of attaching tendons at a new point in the periosteum is that the operator has a free selection of the point of insertion for the transplanted tendon. Where the tendon is too short to reach the periosteal insertion, it may be attached by silk strands, which afterwards become enclosed in a deposit of fibrous tissue, layer upon layer, so that it, after a time, becomes a tendinous band in the centre of which is the silk thread. The after treatment is the same as described heretofore.

It is desirable to fix the parts preceeding the operation for six to eight weeks in the expectant ultimate position, mation, of the tendons with no danger to tearing out of sutures.

Satisfactory results of transplanted tendons depend this preparation will enable a more accurate approx-ito a great extent upon the following ennumerated technical points: I. Make correct diagnosis of paralyzed muscles and make your plan for operation accordingly, and observe strict technic of transplantation minutely and faultlessly with strict asepsis. II. Fix parts carefully in a slightly over-corrected position and apply plaster of paris retentive dressing carefully. III. Be careful in manipulation of the parts in after-treatment and the accurate re-application of the retentive apparatus to prevent tearing of the approximated tendons.

Case I. Anterior poleomyelitis, right leg involved. Child, C. C. Age nine, was first seen in the fall of 1907. The child at the age of three was suddenly seized by a

vomiting spell while at walk. She was unable to rise and had to be carried home, where for several days she had a high fever. Osteopathy was used for three years. Examination revealed that the right leg was very much atrophied, comparative measurements of thighs showed a difference of one and one-half inches and at the calf one inch, there was a shortening of the leg of one-half inch, the heel did not touch the ground on account of contracted tendo achillis. (Talipes Equinus.)

Treatment: Massage, active and resistive exercises with electricity were given as indicated by progress of treatment. Out door living and nutritious diet were prescribed and the patient by this treatment gradually improved. The difference of comparative measurements of thighs was reduced to one-half inch and that of the calves to one quarter inch. The Anderson tenotomy of the tendo achillis was done and the child is now able to bring the heel down and to walk more naturally.

Case II. Infantile paralysis (hemiplegia) involving the whole left side. Child S. S. Age 12, first saw her in September 1909. Examination showed marked assymetery of the face, head was bent to the right. The comparative measurements varied from 0.3 of an inch to two inches. Spine showed in the dorsal region lateral diviation of 0.8 of an inch. Left foot was in a talipes valgus position. Flexors and extensors of hand and forearm were involved, the extensors being more affected, so that the hand was in a habitual attitude of palmar flexion of a right angle with adduction of thumb. Contractile power of left hand was two pounds and that of right hand was thirty-four pounds. This patient had never been treated.

Treatment: Out door active exercises, nutritious food, cold sponge bath with vigorous rub down, localized resistive exercises to improve the undersized muscles and electricity were ordered. Special attention was given to the hand and foot. A special ankle and foot brace was worn and corrective exercises given with good results. The hand was carried in a over-corrected position, thumb

adducted in a light removable plaster cast for two months in order to relax the flexor tendons and prepare for shortening of extensor tendons by operation. The tendons of the extensor communis digiti were shortened and the adductor pollicis transversus and adductor pollicis obliquos were divided in order to move the thumb out of the way of the index finger. The result of the operation has been very satisfactory as far as appearance is concerned, the parts are still carried in the retentive splints which are removed three times a day when passive and active exercises are taken. The contractile power of the left hand has increased eight pounds.

Case III. Another poleomyelitis, involving left leg and foot. A boy six years old was brought to me by a masseur who had given the patient massage and exercise for two years. The treatment given up to this time had restored the action of the muscles and had stimulated growth of muscular fibres.

Examination showed that the patient was in a fairly good physical condition, but the boy was unable to flex his foot due to the paralyzed condition of the tibialis anticus muscle, the tendo achillis had not contracted, due to the persistant continuous exercises. I suggested operation, which was accepted.

Treatment: Applied plaster cast to the parts in a dorsal flexed position and kept the foot in this condition for two months, taking it out of the cast three times a day for the purpose of massage, active exercise and electricity. I then performed complete tendon transplantation of the extensor hallucis and proceeded with the after treatment as outlined heretofore with good results, the boy now walks naturally.

REPORT OF A CASE OF PARINAUD'S CONJUNC

TIVITIS IN A NEGRO.

Wm. C. Kellogg, M.D., Augusta, Ga.

On September 28th, 1909, a negro boy seven years old was brought to my office with the following history:

About three week's previous the left eye had begun to feel sandy and a small amount of thin discharge formed at night; enough to stick the lids together. Day by day the discharge had increased in amount until the eye had to be washed four or five times a day and it was only with difficulty that it could be opened at all.

There had been at no time any pain or discomfort other than that incident to the gumming from the discharge.

There was no history of tuberculosis in the family. The patient had had measles about two years before and though not strong or robust had never had any other sickness. The child had lived in town all his life. He had never been thrown with horses or cattle to any extent. The examination showed a fairly well- nourished child apparently about the given age, seven years. The left eye was closed and exuding from the palpebral slit was considerable thin, yellowish, sticky discharge which had matted the lashes and rendered the opening of the eye somewhat difficult. There was some swelling of the lower lid especially toward the outer canthus, though the lid was not oedematous.

When everted, the lower lid presented three pea sized lumps which popped into view as the lid was turned. These were sessile and massed together near the outer canthus. From the region of these tumors the discharge apparently came, for as the conjunctiva was cleaned the flow could be seen oozing slowly from between the masses

which were distinct and could be isolated one by one. The conjunctiva of the lower lid was smooth throughout except over the tops of the masses and here it appeared rough and corrugated. There was apparently no departure from normal in the conjunctiva of the upper lid. The bulbar conjunctive was clear white, the cornea normal; reaction to light and accommodation and tension also normal.

There was, however, marked, though not complete ptosis of the affected eye, the sub-maxillary gland was about the size of an English walnut and the lymphatics in the left side of the neck were generally palpable.

The right eye was perfectly normal. There was no adenopathy of the right neck.

The epitrochlears were not palpable. The teeth were good and showed no signs of lues.

Smears made from the infected eye showed practically no bacteria of any sort.

The child was given a ten per cent. solution of argyrol to use every four hours and, as the discharge rapidly improved, about a week later was taken to the hospital and under general anesthesia the three masses were removed by scissors dissection. The bases of these masses were dense and seemed to lie deeply within the tissues of the lid.

Subsequent treatment consisted in frequent cleaning with boric acid and the use of ten per cent argyrol every three or four hours. The discharge persisted, though in lessening quantity for nearly three months, though the sub-maxillary enlargement disappeared in about two weeks' time after treatment was begun.

The ptosis lasted about one month.

This case was subsequently lost to view until April 11th, 1910, at that date I found the left eye well in every way. There were no palpable glands in the left neck. The lower lid conjunctiva showed faint scars only of where the tumor masses had once been and the induration of the tumor bases had cleared up.